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Haryu S, Niizuma K, Endo H, Sato K, Watanabe M, Tominaga T. Case of Clear Cell Ependymoma Successfully Treated with Preoperative Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 14:394-399. [PMID: 37501672 PMCID: PMC10370905 DOI: 10.5797/jnet.cr.2020-0050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/30/2020] [Indexed: 07/29/2023]
Abstract
Objective Clear cell ependymoma (CCE) is known to be very similar to hemangioblastoma (HB) in regards to neuroimaging and histopathology. We report a rare case of CCE in which successfully underwent preoperative embolization with a prior diagnosis of HB. Case Presentation A 58-year-old woman presented with vertigo for several months. MRI showed the right cerebellar tumor mimicking solid HB. DSA revealed the hypervascular tumor supplied by branches of the posterior inferior cerebellar artery (PICA). To reduce intraoperative bleeding, preoperative embolization was performed using n-butyl-2-cyanoacrylate (NBCA). A flow-guided microcatheter was guided to the proper feeders, and diluted NBCA was injected. Sufficient devascularization was achieved. The tumor was totally resected with minimal blood loss the next day. Postoperative pathological diagnosis was CCE. Conclusion This is the first report that preoperative embolization was performed to CCE with careful techniques and recent advanced devices. Since CCE has a poorer prognosis, preoperative embolization for safety total resection may be more important.
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Affiliation(s)
- Shinya Haryu
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hidenori Endo
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenichi Sato
- Department of Neuroendovascular Therapy, Kohnan Hospital, Sendai, Miyagi, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Abstract
Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) with different radiotracers enable regional evaluation of blood flow and glucose metabolism, of receptors and transporters of several molecules, and of abnormal deposition of peptides and proteins in the brain. The cerebellum has been used as a reference region for different radiotracers in several disease conditions. Whole-brain voxel-wise analysis is not affected by a priori knowledge bias and should be preferred. SPECT and PET have contributed to establishing the cerebellum role in motion, cognition, and emotion control in physiologic and pathophysiologic conditions. The basic abnormal imaging findings include decreased or increased uptake of flow or metabolism tracers in the cerebellum alone or as part of a network. Decreased uptake is generally observed in primary structural damage of the cerebellum, but can also represent a distant effect of cerebral damage (crossed diaschisis). Increased uptake can be observed in Freidreich ataxia, inflammatory or immune-mediated diseases of the cerebellum, and in status epilepticus. The possibility is also recognized that primary structural damage of the cerebellum might determine distance effects on other brain structures (reversed diaschisis). So far, SPECT and PET have been predominantly used in clinical studies to investigate cerebellar changes in neurologic and psychiatric diseases and in connection with pharmacologic, transcranial magnetic stimulation, deep-brain stimulation, or surgical treatments.
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Zhang XP, Liu Y, Zhang D, Zheng Q, Wang C, Wang L, Li QC, Qiu XS, Wang EH. Cerebellar ependymoma with overlapping features of clear-cell and tanycytic variants mimicking hemangioblastoma: a case report and literature review. Diagn Pathol 2017; 12:28. [PMID: 28320419 PMCID: PMC5359883 DOI: 10.1186/s13000-017-0619-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Imaging and histology of clear-cell ependymoma and cerebellum-based hemangioblastoma are similar; distinguishing between them is a diagnostic challenge. CASE PRESENTATION A 62-year-old Chinese woman presented with an intermittent headache of 8 years' duration. Computed tomography and magnetic resonance imaging revealed a mass in the cerebellum. Neurological imaging suggested hemangioblastoma (HB). Histologically, the tumor included cellular and paucicellular areas, in which cells were arranged in nests or diffusely distributed; and a highly vascular area, in which tumor cells were arranged in clusters and separated by capillaries. At low magnification, the tumor mimicked cellular HB, but at high magnification, tumor cells showed clear cytoplasm instead of the vacuolated cytoplasm typically observed in HB. Moreover, spindly, bipolar elements resembling tanycytes were observed within the nest structures. Although these features indicated the possibility of ependymoma, neither true ependymal rosettes nor an ependymal-lined profile was observed. The tumor was characterized by prominent vascularity, but glomeruloid formation was absent. We saw pleomorphism in foci of some tumor giant cells, but pathologic mitosis and palisaded necrosis were absent. Most tumor cells were positive for glial fibrillary acidic protein and S100. Epithelial membrane antigen was expressed with a paranuclear dot-like or a ring-like pattern. The Ki-67 index was approximately 2%. Considering the patient's symptom, neurological imaging, and pathological findings, she was diagnosed as cerebellar ependymoma (WHO grade II). CONCLUSIONS Here, we report a case of ependymoma with overlapping clear-cell and tanycytic features, and review the literature to evaluate its real incidence. Pathologists should consider this rare diagnosis when confronted with a similar presentation.
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Affiliation(s)
- Xiu-Peng Zhang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - Yang Liu
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China. .,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China.
| | - Di Zhang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - Qin Zheng
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - Chen Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - Liang Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - Qing-Chang Li
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - Xue-Shan Qiu
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
| | - En-Hua Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, 110001, China.,Institute of Pathology and Pathophysiology, China Medical University, Shenyang, 110001, China
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Abstract
Multiple vascular patterns are presented in tumors of the central nervous system (CNS), including microvascular hyperplasia, branching capillaries, numerous capillaries without definite pattern, hyalinized vessels, and angiomatous area. These vascular patterns play important roles in pathological diagnosis of brain tumors. Because of insufficient recognition of the significance of the various vascular patterns, only a few of them have been applied in pathological diagnosis, leading to missed diagnosis and diagnostic errors. Microvascular hyperplasia can present in multiple brain tumors but display different diagnostic values. Otherwise, varied brain tumors characterized by branching capillaries or vascular pattern mimicking branching capillaries should be given careful consideration. Therefore, a familiarity of these tumors and their vascular pattern is essential for general pathologists. This study reviews the value of various kinds of vascular patterns for pathological diagnosis of brain tumors, constructs a framework for better understanding, and provides a novel perspective for general pathologists.
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Affiliation(s)
- Jing Zhou
- Department of Pathology, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China.
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